Human leukocyte antigen-g level, hematological and biochemical profile among pregnant women with plasmodium falciparum (pf) infection: A case control study at the bibiani anhwiaso bekwai municipality, Ghana

Abstract

Immune-suppressive ability of HLA-G and its binding to foetal maternal interface predispose pregnant women to Plasmodium falciparum (Pf) infection and pregnancy loss respectively. However, alterations in hematological parameters accelerate the severity of malaria infection. In addition, the effects of malaria infection on hepatocytes endanger the life of both the mother and the foetus to liver injury. The study assessed HLA-G levels, hematological and liver biochemical profile among Pf infected and uninfected pregnant women in the Bibiani Anhwiaso Bekwai Municipality, Ghana. The study was a case control one with 92 pregnant women consisting of 46 Pf infected (cases) and 46 Pf uninfected (as control) from the municipality. Convenience sampling and structured questionnaire were employed to collect socio-demographic, antimalarial intermittent preventive treatment (IPT-SP), insecticide treated mosquito net (ITN’s) and miscarriage data. Using a first response Pf HRP2 RDT test kit, whole blood samples were tested for the presence of Pf parasites. Hematological and liver biochemical profile were done using automated hematology and chemistry analyzer respectively. Serological tests: Hepatitis B, Hepatitis C and Human Immunodeficiency Virus were done using the appropriate test kits/ strips following the manufacturer’s protocol. Plasma HLA-G levels were assayed using sandwich ELISA (Maxisop Elisa plate) and corresponding concentrations were obtained using ADAMSEL Software. Clinical characteristics: IPT-SP (p=0.007) and Temperature (p=0.045) were significantly associated among the cases and the control group. However, there were no significant association between trimester, ITN’s usage, age and educational status (p>0.05). HLA-G levels insignificantly increased among the cases as compared to the control group (p>0.05) and was significantly associated with miscarriage (p=0.001) with no association between the hematological parameters. Also, there were no statistical association between liver biochemistry and miscarriage (p>0.05). Pf infection was positively associated with ALT (p=0.011), ALP (p=0.017, p=0.02) with or without adjustment respectively and a significant association with percent lymphocytes (p=0.04) and percent granulocytes (p=0.03). Pf infection has effect on liver biomarkers (ALT and ALP) with decrease percent lymphocyte and an increase percent granulocyte among pregnant women with malaria infection. Again, higher plasma HLA-G was associated with previous miscarriage status among the pregnant women. However, the study shows increase levels of HLA-G among Pf infected pregnant women.